Singin' Doo Wah Diddy Diddy Dum Diddy Doo

I MATCHED!!!!!!!!!!!!!!!!

Just in case you didn't hear me:

I MATTTTTTCHEDDDDDD!!!

I was a nervous wreck for about a week, and I had a lot of difficulty sleeping. Friday and Saturday I was in just about the foulest mood possible going into work...not always a good thing. Sunday we did nothing but watch TV. I was definitely not the most pleasant person to be around. I didn't want to talk. I didn't want to think. I wanted total mindless activity just for a few days, which is normally unlike me.

This morning I woke up earlier than usual. Decided to tackle some laundry. Then I decided to de-stress with a p90X stretch video...which worked until I pulled my left trapezius muscle. Oh well, whatever! I took a shower and a few minutes later I had an email telling me I have a jay-oh-bee.

This is probably the last post that I'm going to make with the "medical school" label on it! So weird and freaky!!

Medical School: Done

It's so weird to say that. After everything, that good, bad, ugly, and sleep-deprived indifferent, like *that* it's all over, and three days later I've started what is (hopefully) a temporary job until residency starts in July. 

I don't think I know how to process it all at this time. 

Lots of bad moods, a few bad days. Long long long long long long long endlessly long study sessions. Several really big exams. Distance from family (though that also had a few pluses), travel, concerns about finances. It's all over. Over. I have to say it's a little anticlimactic, because all I can think about is how much I want to go to sleep.

Holy Cow

Yesterday was my penultimate shift in the ER...and medical school. I walk into the unit and the first thing I hear was "She's trying to start a fire with her cigarette!" Welcome to work!!! This was a very challenging patient! She had been brought in the ambulance, for a reason we weren't sure because the report had the wrong name, ethnicity, and date of birth on it, so we couldn't trust it. As soon as she got put in the room she decided she wanted to leave,  so she lit a cigarette and tried to set her bed on fire. Her mood depended on the moment. She could be very nice and cooperative or completely belligerent. She hated blacks and Filipinos, but being gay was ok as long as it was your business. Her family had all been murdered by doctors. Her mother had been beaten to death at a nursing home. She was an atheist. Then she wanted her Bible and was going to forgive everyone because she was a Christian and would forgive. She was verbally abusive the entire.night.

We had another patient who came in because she was experiencing seizures. She was telling us that "I'm having one right now." While she's wide awake and walking. A quick check to her record reveals a diagnosis of paranoid schizophrenia. She was also a real pain in the ass. She was belligerent until the nurses made it clear that she was not going to be allowed to be disruptive. Sometimes dealing with these patients is like dealing with a six year-old.

Most of our patients that night were serious. Which is a bit out of the ordinary. In the ER a lot of the patients really don't have emergencies. Mexican moms in particular bring their kid to the ER every time they throw up. This is not an emergency. Kids get sick, and they throw up every once in a while. If it does not stop or is accompanied by a very high fever, and cough, or the vomit looks weird, that's different. But one episode of vomiting does not an emergency make.

Aren't They a Gem...I'll drink to them!

Ok, so I took the title of this post from a line in the song "The Ladies Who Lunch," of the musical Company. I'm not a theater geek, but I do enjoy it from time to time, and particularly the snarky variety. Anyway, the song itself is a snarky swipe at judgment and cynicism. For me that was a bit of the last couple shifts. I've found myself using the word "gem" over and over again. Perhaps just a little too much.

I've had some terrible patients in the ER, and a further taste of what's to come. I've certainly seen psychotic patients, so their behavior wasn't new, but it has actually been a while, so it was a refresher.

One patient had left his nursing home over ten miles away and had bounced from hospital to hospital, subsequently signing himself out. By the time he got to Chicago Hope's ER it was later in the day, and after a short while he it became apparent he had missed his afternoon medications because he became what is referred to medically as acutely psychotic. In layman's terms he flipped his lid. He started calling everybody a "fucking nigger." Security had been called and one of the security officers simply looked at him, smiled, and said "thank you!" Brilliant, I thought. I'm going to have to remember that.

The next day another patient came in, and we had just gotten him discharged when he decided that he could not find his wallet. Not only could he not ifnd it, but he insisted that somebody had reached into the back pocket of his pants, while he was seated in a wheelchair the entire time, and taken his wallet. And he was not leaving until he got his wallet back. That certainly was interesting.

That same day we had a patient who was brought in by his mother. He did not want to be there. He kept telling his mother how he was going to get his wallet, go down to the club (I didn't find out which one...) have him some BEER, and hang out with some GURLS. This was a 30-something year-old man. I felt sorry for his mother.

It's just been interesting. We also had a patient with a rotten foot. Over half of it was black. Oh my god did it smell. The smell stayed in my nostrils most of the night. I felt like dipping my head in a vat of rubbing alcohol to see if that would kill the smell.

What a gem of a day!!

Today was my last early (6a-2p) shift in the ER...thank God. I'm sure there will be periods of time when I'll need to be awake that early for residency, but I guess I'll have to cross that bridge when I get to it. A friend of mine is doing a surgery rotation in California and he has to get up every day at 4:30. Excuse me?? Je ne comprends pas!  That hour does not compute. And you want to go into this field why?? But I'm getting off track. Today was an interesting day.

For starters, I had a new attending today. Always awkward. He spent twenty-five minutes lecturing my fellow students about brevity...

I walked into a room to find that both people in the room were expecting to be treated. This isn't exactly typical, so I just hopped back to the desk to make sure that both patients indeed were registered before I went through the rigamarole of examining both of them. I don't typically read too much about a patient before I see them because I want to see them from scratch. Good thing I did that, too. Both patients, indeed, were registered. For genital discharge. Oh goody. I must've made some sort of face, or audible expression because half the staff at the desk and the attending started to laugh. It became clear at that point that the attending was purposefully not seeing that patient before whichever schmuck of a student got lucky and took that patient. Thankfully a thorough examination was not necessary. What I did observe however, was that the female (aged 21) had this ever so sexy habit of sucking on her thumb while she was talking. Yes ma'am. Nothin' says sexy more than a 21 year-old who can't speak English properly AND sucks her thumb. Mmmmm baby. Oh, and by the way, soap is cheap. Please use it more than twice a month. You reek. The 20 year-old guy in the pair was clueless. Or stone. Or perhaps both. I don't know. He just kept walking around like he didn't realize he was in a room...with walls. I kept waiting for him to hit a wall and then bounce off of it in a daze. Really, a real pair these two were. What a special time I'm sure this was in their relationship. Getting treated...together...for the clap. They got sent home with a shot of ceftriaxone, and scrips for azithromycin and doxycycline. Please don't ever come to the ER for STIs again. I will hurt you. And I have the right to do so, since I'm paying for your ER visit. Also, wear a damn condom because I really don't want to have to pay for the baby you two chuckleheads will invariably make...and not know how.

I also correctly diagnosed a migraine from presentation! Thank you neurology and awesome neurology attending. I'm not sure I would have recognized it as a migraine off the bat without that experience. Go me?

I diagnosed several URIs in kids under two. It's that time of year folks. I understand love for one's children, but I also think that when 16 year-olds start bringing their 19 month-old children into the ER because they are PANICKED because they have been coughing for six hours...that it's time to stop letting uneducated 16 year-olds have children. This brilliant girl didn't grasp, despite several declarations, that a bottle, is indeed feeding a child. Oy, some people. 

I had more than one patient whose parents didn't speak English. And I found myself rattling off Spanish like I actually knew what I was saying. Weird. I have days like that every once in a while, but few and far between.

Emergency!!

I'm about a week into my last (!!!!) rotation: Emergency Medicine. I figured that this would be a good one to end with because my interest in doing another rotation is pretty much nil, and this would at least keep me moving and doing something. And so far that has indeed, happened which has been great. The schedule? Not so much. Because of interviews (mine and everyone else's) what is normally four or five overnights in a row, followed by the name number of morning shifts, and the same number of day shifts, and totally been thrown askew. Everybody is gone at random times, and as such the schedule is totally random. It messes with my sleep schedule (I know, I just have it so rough). 

Got to incise and rain and abscess. Had done it before in surgery, but they patient was unconscious. This guy was awake.

Had a rather strange occurrence, a patient came in for whatever reason with her mother. Mother had been there for about four hours (and I saw her sitting more or less content and comfortable) when she decided to inform the staff that she had been suffering from gastritis for about a week and needed to be seen. I'm not sure what to make of that.

So a full-blown tonic-clonic seizure, which was kind of cool.

Had more than one schizophrenic patient (one with pronounced tardive dyskinesia) who proceeded to make their presence very well known, which for me as a future (hopefully) psychiatrist was good experience and a bit interesting.

I've been on the interview trail for the past month as well...and goodness between the travel and the interviews themselves and working that around my rotation schedule it has definitely been interesting. They have for the most part been fun and enjoyable. But there's always this feeling of inadequacy within me, and I have no idea how it's going to turn out. Stay tuned for updates.

This and that...

Just some random thoughts from my patient encounters in the past week or so.

It's realllly bad when you let out an SBD and the room suddenly smells better than it did a second ago. Why? Because the patient in the room smells like a rabbit cage. I used to have rabbits and their cages had a very distinct smell.

Why do you need to ask someone who smells like an ash tray, with wheezing you can hear from across the room, whether or not they smoke?!? DUH!!! Of course they smoke! The better question is probably how many cigarettes they smoke per day!

A patient's spouse commenting on one of the side effects of ketoconazole, which is being used for a patient's prostate cancer: "Is that why he don't get horny? You gotta do something about that." Do I laugh, or wet myself??

Heme/Onc...

...not really my favorite I have to say. The subject matter is somewhat interesting, but at this point I must confess to some senioritis and I just am not interested. To boot, I work with two different doctors, both of whom can annoy me in their own special way. The first is an older doctor who thinks he is absolutely hilarious, and can talk up a storm about absolutely nothing. I swear I spend an extra hour at the hospital than I need to just because he's yacking about nothing. The second thinks he's really hilarious, and likes to joke in the form of harassment. At 7:15 in the morning I'm not always in the mood for it...really not in the mood for it.  That's not to say I'm complaining, but with the first doc especially I don't feel like I get to do anything. I just follow him around the clinic and the hospital for about eight hours. And I don't get to even write a note, or listen to a heart. I'm six weeks away from being done with medical school. I would like to think I could at least do something that simple.

I Didn't Know Carrots Were Served That Way

Had one of THE most interesting cases in the OR today. I was going through pre-op and saw a patient who wasn't on the schedule (always a good sign) so I asked the secretery. 

"Removal of foreign body from the rectum," was my answer. Oh goody! We had one of those last year and it was a Starbucks frappucino glass bottle. Genius. I asked the patient, discreetly as possible, what happened. He states that he was drinking Saturday night and does not remember much of anything. He states that his friends must've inserted whatever the object was into his rectum. Ummm, ok, sounds like a stretch but let's keep everything open to possibilities. Said patient also knew his birthday, but was seven years off on how old he is. So we're looking a patient with memory (likely related to alcohol) issues. Which means he's going to need higher doses of anesthetic. 

The ER report made note of an X-ray that indicated the foreign body so I finished my pre-op stuff and went to have a look. I wish I could post it but blast that HIPPA. What we saw was a rather non-descript but definitely distinct object that did not belong there. We all took guesses (yes folks medical students do discuss their cases).  Some said a bottle. Some said dildos. One person even said a plastic bottle (which I'm not sure how that would work). Anyway, it came time to take it out. After a few attempts the doctor requested that the patient be completely paralyzed because he just couldn't get it to come out. He could feel it, however, and said that whatever it was it was "wrapped in a condom." By this point half the OR staff and all of the students within earshot are in the room (the poor patient), waiting for the moment when it is extracted. It finally came out, and it turned out to be a carrot, and a rather large one at that. 

Yeah dude...your friends are such douches that they'd shove a carrot up your ass but they were nice enough to bag it up. I'm not buying it. 

Rolling right along

Anesthesia has been ok. Nothing terrific. Nothing that I really feel has been overly enjoyable (or unenjoyable for that matter) so I'm just kind of getting through it. Meh. What can you do. 

I don't have a ton of stories to tell, because a lot of the patient interaction is short, limited to pre-anesthesia stuff (I'd love to but I don't have time for your story today, I just need your meds and surgical history, kthnxbai that's all). I frequently get called to help out my partners because neither of them speak Spanish and at least half of our patients only speak Spanish, and I speak enough to get through an interview. So that's that.

In the OR I've tried intubation almost every day, but it isn't clicking yet. IVs I've been pretty successful with, but the tricky ones still prove...well tricky. Beyond frustrating are the IVs where I get the needle in the vein, but then lose the blood flow for various reasons such as bad veins, collapsed veins, the needle going through the other side of the vein because I inaccurately anticipated a curve in the vein. When such events happen I have to inform the patient that a nurse will be sticking them a second time, because I the lowly student am only allowed one stick. 

Interview Season Has Begun!

...and I'm (predictably) a neurotic mess on the inside. I try to contain it outwardly--because who really cares. I make little jokes about myself and how I check my phone all the time like I expect to get an email from a program. I have a few interviews lined up, but I always want more (insert laugh here). 

In reality there is no rhyme or reason to which program selects me for an interview as opposed to programs that have chosen to decline me for an interview. And that drives me nuts. 

In local news, anesthesia is rolling right along. And I find it not my favorite. But it's still somewhat interesting. I'm trying to do more intubations and IVs. I'm attempting more difficult ones so my success rate has gone down. On Friday I attempted one with tiny veins, and I ended up going through the vein. Today I tried one that not only rolled, but only half of it rolled so a straight line turned into an S. I have a new respect for nurses.

Anesthesia...but I don't feel anything...

The past week or so I've been back at Chicago Hope Hospital. It's been quite nice, and a little surreal. I spent close to a year at this place, being here every single day, and then I left for quite some time, to return and have a lot of things look, sound, and smell the same. A lot of memories came flooding back. It's quite rare for me to return to a place once I've left it. I must say it is a much more pleasant environment than Chicago Memorial Hospital. Getting here is much easier and/or pleasant than Chicago Memorial because I can take an express bus to an el line, and it moves much quicker. The staff is infinitely more pleasant and friendly, and much more open to interaction than the staff at Chicago Memorial. I'm glad I decided to schedule my last three electives here. 

So...now to anesthesia. How boring can one discipline be?? The science is indeed quite interesting, the practice of it does nothing for me. It's about ten minutes of work, then over an hour of doing nothing in the hopes that indeed nothing happens. The anesthesiologist and CRNA spend a lot of time on their eReaders and what not. I've been able to do a few things such as:

 Insert an LMA

Attempt an intubation -- due to uncertainty I haven't quite landed one yet.

Successfully figured out how to insert IVs

Spinal

Induced with general anesthesia, which with the IV isn't that thrilling.

Observed a prostate ablation -- which looks quite frightening when done with a laser.

All in all I'm confident in saying that I'm glad I didn't  choose anesthesia or ever have strong interest in it.

Application Time!!!

Applications for residency went out yesterday morning. Can you say freak out?!? I certainly did! I was a nervous wreck most of the morning as I went over my list one more time (and good thing, too, I changed and added a few programs). It was not cheap. And the whole bloody thing is reminiscent of the medical school application process, which wasn't a barrel of laughs either. I was almost shaking as I pressed "Apply." I then spent most of the day worrying about whether or not I get interviews. Sometimes I have zero confidence. It didn't help that it basically rained all day yesterday so I couldn't go for a walk or bike ride to help clear my head.

Neurology...DDDDDDDONE

Finished my neurology rotation. I must say I thoroughly enjoyed what I learned and working with this particularly attending. I didn't care so much for his preferred hours. I'm an early bird. I don't mind waking up at six to get to work by seven, or earlier, and leave so I can eat dinner at a reasonable hour.  Dr. Brain is a night owl. He prefers coming in at 11:30 and staying until 8 or later. That means we stayed with him until 8, 8:30 most nights. I felt like I learned A LOT. I got my neuro exam time down to less than thirty minutes. The first time it took me well over an hour. My attending offered me a letter of recommendation. I didn't ask for one. I had planned to, but he offered before I had what I thought was the appropriate chance. So woohoo!

Next up for me is a two week break (what WILL I do with myself??) and then I have three more rotations. I'm going back to Chicago Hope Hospital, and I'm looking forward to it. Chicago Memorial Hospital was a good place to learn, but the nurses there, particularly in the ICU can be real curmudgeons. 

Let's Geek Out!!

Neurology is rolling right along. Yesterday I was basically one-on-one with my attending because my partner took two (yes TWO hours) to see and write a report on a patient who is for all intents and purposes braindead. I have many questions...but moving along. The first patient had an array of symptoms that were fascinating to observe as a student. He had a present Babinski sign on the L, a L ankle clonus, and diminished L knee reflex. I became unnecessarily excited when I observed the Babinski: "Um, doctor, I think this is an upgoing Babinski. Do you want to verify?" I was indeed! Same with the clonus. I didn't see it, but felt the ankle jerk an extra time after the initial reflex, which I initially didn't think anything of, but after a second I asked the doctor to verify that as well, and indeed, I was paying close attention! Go me??

Later, we had a patient who has a history of thrombotic thrombocytopenic pupura. She had significant neurological damage. She had a rubral tremor, and noticeable cognitive impairment. Getting her to do Serial 3's (1, 4, 7, 10, 13...etc), you'd think I was asking her to do quantum mechanics. So all in all the doctor said I did very well with those cases.

Fast forward to today. We had a patient come in who on top of being hard of hearing didn't speak English as her first language (not unusual). We knew ahead of time that she had a pontine lesion, so the attending asked us to pay special attention to her cranial nerves. I noticed what I found out to be square wave jerks in her eyes. The doctor did not notice that immediately while my partner was doing the exam, and appreciated me calling it to his attention. Also this morning we had a patient who was known to the doctor. He had me examine her cold and to find her abnormality. I correctly diagnosed her problem as an ulnar nerve neuropathy. She had a noticeable left palpebrae that wasn't equal to the right, and I noticed she also had a slight left-sided mouth droop while the doctor was addressing a sensory complaint in her arm. I was able to bring that to his attention. I felt unnecessarily accomplished, and totally geeked out. 

I'll leave with some awesomely bad jokes from my attending:

Did you hear about the Invisible man ? He married an invisible woman. Their kids aren't much to look at.

Disgruntled patient who just happens to be an NRA member: "If another doctor tells me there's nothing wrong with me I'll kill him."

Doc: "There's definitely something wrong with you." 

A big giant WHY...

This morning my attending asked my partner and I to evaluate a seizure patient...but wait!!! The patient is sedated. Hope the attending doesn't mind ten pages of "unable to assess."


Follow up!!: As I was reading through the previous notes (the patient has been in the hospital for quite a while) I came across a real gem. According to a wonderfully written progress note: "Pt had this morning that lasted for 30 min..." Pray tell what did he have? Seizures? Vomiting? Headache? Fits of rage? Priapism? I'm all ears doc...

Today's Observations

1. It's 85 degrees, unless you're from Saudi Arabia and find that cold, why are you wearing a scarf??

2. Anyone attempting a left turn at Addison and Clark on Cubs game day needs their head examined. And deserves to be tazed for backing up traffic even more...because you know they're never going to get to actually make that turn.

3. I like neurology. My attending says I'm doing well and has allowed me to do exams on my own. However, I was thinking about going into neurology before this rotation. I find it interesting, but I am no longer considering neurology.

Neurology

This week I started my neurology rotation. It's been interesting, but also a lot of work. I don't really mind it. I'm not crazy about the hours, however. They aren't long, but they are late, so they might as well be long. I haven't been getting home until after eight most evenings. I'm accustomed to getting up and out early, and doing my errands in the evening. This means I have to reverse that pattern for a few weeks, which is kind of weird.

The doctor is nice, but sometimes the way he talks makes him come across as a bit of a jerk. For example, yesterday he was quizzing us about random neurological signs, and I hadn't the foggiest clue what the sign was. I asked him if he could spell "Lhermitte's" sign, and he just replied "No."...Thanks dude. I've never heard of that, or if I have it has long been forgotten.

I'll be the first to admit neuroanatomy was not my favorite or best subject. I think you have to be a witchdoctor to understand a lot of the pathways and crossings.

Yesterday we had neurology clinic, and we have several new patients. The first patient of the day, the doctor said "Okay luckyone, you're going to do the exam. Unless you would prefer me to do it, this might be a difficult case." Well, of course I'm not going to back down from that. Sink or swim I told him I would be fine to do the exam, even though I was indeed nervous. I started taking my history, and not too long after I started he suggested that I not ask quite so specific questions, which threw my rhythm off a bit as I was trying to ensure that I didn't get reprimanded for asking "too specific questions." Nerves, but oh well. I'll get there. So, I was trying to concentrate on asking broader questions, and it needed a bit of work. Some of the things he noted that I didn't ask or facts that I didn't obtain I recall indeed obtaining. Perhaps not the proper way or to his liking, but I did get that information.

My exam was fine, I think. A bit unorganized, but I have never done a complete neuro exam before and I didn't want to do it by the list because the order looked a bit weird to me. Maybe I'm slightly dyslexic, but I stay on track easier if I do things in groups. I only had to be corrected on one task, and that was just a brainfart.

QOTD

"I had a patient once who tried to commit suicide by shooting herself in the neck. She missed everything. When I asked her about the pain, she described it as a shooting pain. I had to excuse myself from the room to avoid laughing."

Moral of the story: when you attempt suicide either make it count, or at least work on your descriptors.

Good to Know...

Patient: "Please leave the room and close the door. Lucifer is trying to have sex with me." Patient is actively simulating the act and mentioning how delicious Lucifer's penis apparently is.

Sure, no problem. Mad dash for the Haldol.